Incidence of severe rotaviral disease is decreasing

Posted9/20/2014 7:00 AM

Somewhat bleary-eyed, I pushed the elevator button and made my early morning trip up to the hospital pediatric ward. As the doors opened, I was greeted by the sounds and smells of winter illness: the soft hum of multiple nebulizer treatments and the characteristic sickly sweet smell of poopy rotavirus diapers.

Welcome to pediatric residency 20-some years ago when the two prevailing reasons for "sick season" hospital admissions were episodes of virally induced wheezing and bouts of rotaviral gastroenteritis with dehydration.

Fast forward to present time and the wheezing is still with us, but thanks to newer vaccines, U.S. pediatricians now rarely see severe illness caused by that nasty bug, rotavirus.

That's why this past spring I was a little surprised to find one of my patients positive for rotavirus and down and out in a hospital bed. The girl had been hit by a short but violent course of high fever, vomiting, and diarrhea, and had quickly become dehydrated.

With the help of IV fluids, the third-grader improved within 24 hours and headed home. After checking her medical records, I remembered that the family hadn't opted out of or missed the rotavirus vaccine. There was simply no version of this oral immunization available during her infancy.

A rotavirus vaccine was in use in 1998 but was voluntarily pulled from the market in 1999 when a link with a serious intestinal blockage known as intussusception was recognized.

Two newer versions of rotavirus vaccines were introduced: in 2006, the three-dose RotaTeq given at 2, 4, and 6 months of life; and in 2008, the two-dose Rotarix given at 2 and 4 months of life. These two vaccines remain in use today.

In the Redbook of the American Academy of Pediatrics, infectious disease experts explain that rotavirus is highly contagious, with the virus largely spread via the fecal-oral route. Less often, disease occurs after respiratory transmission or through consumption of contaminated food or water. The virus has also been found to hang out on toys and hard surfaces.

Kids can become ill within one to three days of rotavirus exposure. Rapid onset of fever and vomiting is followed in a day or two by profuse, watery diarrhea. Rotavirus usually runs its course in three to eight days.

Hand washing and washing of surfaces can help reduce disease transmission. However, rotavirus incidence can still be a bit hard to predict and control in groups of younger children since rotavirus is present in a patient's feces for several days before he or she shows any signs of illness.

Rotavirus creates a massive global burden of disease. The AAP notes that rotavirus is the leading cause of diarrhea-related deaths worldwide, and in developing countries rotavirus kills 600,000 children under the age of 5 each year.

The good news, reports the pediatric group, is that the incidence of severe rotaviral disease has dramatically decreased in this country since the introduction of the newer rotavirus vaccines.

Between 2006 and 2008, U.S. hospitals recorded a whopping 85 percent decrease in rota-related emergency department visits and hospital admissions.

To put it in perspective, in the 2008 season alone, about 50,000 fewer kids under the age of 5 required hospitalization for gastroenteritis when compared with pre-vaccine admission numbers. Within just a few years of rotavirus vaccine reintroduction, researchers also saw a "substantial" decrease in visits to the doctor's office for stomach flu complaints.

The Centers for Disease Control and Prevention note that some, but not all, safety studies suggest a link between the newer rotavirus vaccines and a possible small increase in the risk of intussusception. The CDC concludes, however that, "The benefits of rotavirus vaccines in preventing hospitalizations and deaths from rotavirus illness far outweigh the small possible risk of intussusception."

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights

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